tbuckley/cabot-search huggingface dataset:
Abstract 9778: The Biological Effects of a Novel Bispecific Designer Peptide (CRRL 094) in a Rat Model of Experimental Diabetes
Authors: Fadi W Adel, Ye Zheng, Shuchong Pan, Syed AMEENUDDIN, Horng Chen
Journal: Circulation (2022)

Introduction: The prevalence of diabetes mellitus (DM) is increasing, and it is associated with cardiorenal dysfunction. Natriuretic peptides (NPs) have cardiorenal protective actions and enhance insulin sensitivity. We designed a dual-action bispecific peptide (CRRL 094) that simultaneously activates the natriuretic peptide system and induces insulin secretion. Methods: To test the in vivo effects of the peptide, Wistar rats (male, 6-8-week-old) were made diabetic by intraperitoneal Streptozotocin (STZ) injection (65 mg/kg). One week after STZ injection, diabetes was confirmed (fasting blood glucose &gt; 350 mg/dL). Rats were then divided into 2 groups: controls (Ctrl group, n=6) and treatment group (Tx group, n= 9). The peptide (1 pmol/kg/min) was infused in the Tx group for 150 min. Results: After 150 minutes of peptide infusion, plasma insulin (mean± standard deviation) increased more than 3.7x among the Tx group compared to the Ctrl group (0.294± 0.199 ng/mL vs 0.078± 0.021 ng/mL, p=0.01). Additionally, plasma glucose decreased among Tx group (405.3±96.4 mg/dL) compared to Ctrl group (545.6± 52.8 mg/dL, p=0.003). Furthermore, the rate of natriuresis increased significantly among the Tx group compared to controls (1.582±0.7 vs 0.639±0.21, p= 0.009), as did the rate of kaliuresis (3.1± 1.1 vs 2.0±0.6, p=0.045). Importantly, the glomerular filtration rate increased by 1.5x among the Tx group compared to the controls (1.6±0.5 vs 1.0±0.3, p= 0.03). There were no significant differences in mean arterial pressure or heart rate. Conclusions: The dual-action insulin-secreting natriuretic peptide (CRRL 094) was effective in increasing endogenous insulin secretion, enhancing natriuresis, and improving renal clearance. Further studies are warranted to assess its long-term safety and efficacy in diabetes.
Abstract 9761: Risk Factors for Cardiopulmonary Resuscitation Among Acute Ischemic Stroke Admissions in the United States; An Overview From the National Inpatient Sample
Authors: Kamleshun Ramphul, Renuka Verma, Nomesh Kumar, Yogeshwaree Ramphul, Komal Kumari, fnu Bawna, Shaheen Sombans, Stephanie G Mejias, Fnu Arti, Petras Lohana, AMR W ALJAREH, Muhammad Umer tufail
Journal: Circulation (2022)

Introduction: Recent studies have shown an improvement in survival among Cardiopulmonary resuscitation (CPR) cases in several situations. However, risk factors of CPR among patients admitted for Acute Ischemic Stroke (AIS) remain uncertain. Methods: Our analysis used the most extensive US inpatient database, the 2019 National Inpatient Sample, to identify patients diagnosed with CPR among adults of ages 40 and more admitted with a principal diagnosis of AIS. We also queried the different cardiac arrhythmias seen in these patients. Multivariable analysis was used to find the adjusted odds ratio(aOR) of requiring cardiopulmonary resuscitation. Results: Our study found 1425 AIS patients requiring cardiopulmonary resuscitation, which was also more common in patients of ages 40-60 (aOR 1.168), diabetics (aOR 1.160), with heart failure (aOR 1.130), hypotension (aOR 1.932), hepatic failure (aOR 3.317), renal failure (aOR 1.856), respiratory failure (aOR 18.223), gastrointestinal hemorrhage (aOR 1.960), hyperkalemia (aOR 2.258), and hypokalemia (aOR 1.265). Smokers (aOR 0.663), Females (aOR 0.878), and those with hyperlipidemia (aOR 0.689) were less likely to need CPR. Several cardiac arrhythmias were noted among those who needed CPR, such as supraventricular tachycardia (6.0% vs. 1.4%), and ventricular tachycardia (19.6% vs. 1.6%), paroxysmal atrial fibrillation (11.9% vs. 9.7%), and ventricular fibrillation (13.3% vs. 0.1%). Finally, CPR patients were slightly younger (mean age 69.82 vs. 70.89) with a longer (mean length of stay 11.48 vs. 5.01 days) hospitalization. A higher mortality rate was also found as 1030 patients died (72.3% vs. 3.6%). Conclusions: We observed several significant potential risk factors for CPR among AIS patients. Further studies, strategies, and changes in protocols among AIS admissions may benefit the long-term prognosis.
Abstract 9699: Phenotypic Features of Coronary Atheroma Associated With Coronary Physiological Mismatch: Insights From Fractional Flow Reserve and Near-Infrared Spectroscopy Findings
Authors: Kota Murai, Yu Kataoka, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Hiroyuki Miura, Satoshi Honda, Masashi Fujino, Shuichi Yoneda, Kensuke Takagi, Fumiyuki Otsuka, Yasuhide Asaumi, Kenichi Tsujita, Teruo Noguchi
Journal: Circulation (2022)

Introduction: FFR and resting indexes (RI) have been recognized as physiological measures to assess myocardial ischemia. Despite their clinical applicability, discrepancy between two measures infrequently occurs. Mechanistically, inducement of hyperemia is a determinant of FFR but not RI. Since lipidic plaque material could be accumulated through endothelial dysfunction, this plaque phenotype may affect vessel response, contributing to physiological mismatch. Near-infrared spectroscopy (NIRS) enables us to evaluate lipidic burden in vivo. Methods: We analyzed 122 target lesions with FFR≤0.80 in 116 stable CAD subjects receiving PCI. Physiological mismatch was defined as FFR≤0.75 and RI&gt;0.89. Physiological indices [RI, FFR and delta-FFR (=resting Pd/Pa-FFR)] and NIRS/IVUS-derived plaque measures were compared in target lesions stratified according to FFR (≤ or &gt;0.75) and RI (≤ or &gt;0.89) values. Results: The averaged FFR, RI and delta-FFR values were 0.73±0.06, 0.86±0.08 and 0.17±0.05, respectively. Physiological mismatch was observed in 10.7% of analyzed lesions. While there was no significant difference in % diameter stenosis across 4 groups (p=0.36), physiological mismatch was associated with a larger % plaque area (max%PA) (p=0.02). Furthermore, greater maximum 4-mm lipid core burden index (maxLCBI 4mm ) was observed in those exhibiting physiological mismatch (Figure). On multivariate analysis, maxLCBI 4mm but not max%PA predicted physiological mismatch (Table). Further analysis demonstrated that lesions causing physiological mismatch more likely exhibited a larger delta-FFR (p&lt;0.01). Of note, delta-FFR was correlated with maxLCBI 4mm (p=0.03, R=0.20) but not max%PA (p=0.09, R=0.15). Conclusions: Lipidic plaque material was a potential contributor to physiological mismatch, driven by its enhanced hyperemic response. Our findings suggest the potential association of lipidic materials with vasomotion and physiological mismatch.
Abstract 9746: Atrial Fibrillation Among the Elderly With Amyloidosis Admitted for Acute Ischemic Stroke in the United States
Authors: Kamleshun Ramphul, Renuka Verma, Nomesh Kumar, Yogeshwaree Ramphul, Muhammad Rahman Khalid, Shaheen Sombans, Stephanie G Mejias, Komal Kumari, Petras Lohana, Fnu Arti
Journal: Circulation (2022)

Introduction: Amyloidosis can disrupt several tissues, including the heart, causing various cardiac arrhythmias. Factors influencing the presence of Atrial Fibrillation in the elderly with amyloidosis admitted for Acute Ischemic Stroke (AIS) have been sparsely studied. Methods: Elderly patients of ages 60 and more with a diagnosis of amyloidosis and a principal diagnosis of Acute Ischemic Stroke (I63.x) were filtered from the 2019 National Inpatient Sample (NIS). All forms of Atrial Fibrillation and multiple risk factors were also identified via their appropriate codes provided by HCUP and based on recommendations from past studies. Results: Our analysis found 1570 elderly amyloidosis patients admitted for AIS in 2019. Among them, 490 cases (31.2%) also had a diagnosis of Atrial Fibrillation. Predictors of atrial fibrillation included hypertension (aOR 1.543, p=0.024), chronic pulmonary disease (aOR 1.541, p&lt;0.01), use of intravenous tissue plasminogen activator (aOR 2.062, p&lt;0.01), old CABG (aOR 3.350, p&lt;0.01), current anticoagulation therapy (aOR 13.426, p&lt;0.01), supraventricular tachycardia (aOR 3.970, p&lt;0.01). Smoking (aOR 0.680, p&lt;0.01), diabetes (aOR 0.597, p&lt;0.01), and ventricular tachycardia (aOR 0.504, p= 0.033) showed lower risks. While a higher mortality rate was seen among patients with Atrial Fibrillation (30 deaths, 6.1% in Atrial Fibrillation vs. 4.6% in others), the result was not statistically significant (p=0.213). Patients with Atrial Fibrillation were also older (80.35 vs. 76.11 years) but had a shorter stay (6.22 vs. 6.81 days) with a lower mean hospital charge ($77,977.01 vs. $78,940.89). Conclusions: While various factors can influence the odds of Atrial Fibrillation in the elderly with amyloidosis admitted for acute ischemic stroke, it did not increase mortality risk.
Abstract 9613: Short- and Long-Term Vascular Responses of Stent With Biodegradable Graft for Artery Dissection in Rabbit Iliac Model
Authors: Sang Min Park
Journal: Circulation (2022)

Introduction: Arterial dissection or rupture during percutaneous angioplasty is rare but can be lethal. We invented a balloon-expandable stent with a very thin membrane typed biodegradable graft for the treatment of arterial dissection (BioGard). Hypothesis: The efficacy and safety of BioGard were evaluated in the rabbit iliac artery rupture model. The devices would be helpful to seal the emergent blood extravasation due to arterial perforation and reduce unfavorable vascular events in long-term follow-up. Method: Twenty iliac arterial dissections by balloon over-inflation were induced under the guidance of angiography. Twelve rabbits with huge contrast extravasation to retroperitoneal space (Ellis type 3) were treated using BioGards. Serial histologic examinations and micro-computed tomography (CT) were performed at 1, 2, and 8 weeks and 3, 6, 9, and 12 months. Final angiography at 1 year was performed to evaluate any vascular complication. Results: There are no significant adverse cardiovascular events after one year of BioGard implantation. Micro-CT and follow-up angiography at one year revealed no case of significant in-stent restenosis and thrombotic occlusion in vivo. Early-stage histologic examination demonstrated that disrupted vessels were completely sealed up by BioGard with mural hematoma, inflammatory cell infiltration, and red thrombi. Mid- and long-term histologic examination revealed patent stents and neointimal coverage over the stents with biodegraded graft material and mild peri-strut area inflammatory response. Conclusions: Twelve months post-BioGard implantation in rabbit iliac artery dissections demonstrated good efficacy and safety. BioGard at a severely dissected artery would be an option for preventing lethal vascular events. Further clinical evaluation of this novel technology would be warranted.
Abstract 9709: Impact of Ventricular Assist Device Use on Pediatric Heart Transplant Waitlist Mortality: Analysis of the SRTR Database
Authors: Arene Butto, Lydia Wright, Chad Y Mao, Jameson Dyal, Richard Garcia, William T Mahle
Journal: Circulation (2022)

Introduction: Children in need of heart transplant (Tx) have a high risk of death on the Tx waitlist due to scarcity of donor organs. Studies of previous eras have shown that ventricular assist devices (VADs) reduce waitlist mortality. We sought to determine whether a survival benefit for VAD patients persists in the current Tx allocation system. Methods: Using the Scientific Registry of Transplant Recipients database, we identified patients listed for primary Tx between 3/22/2016-9/1/2020. Characteristics at time of Tx listing were compared between VAD and non-VAD groups. Cox proportional hazards models were used to identify risk factors for one-year Tx waitlist mortality. Results: Among 5,054 total patients, 764 (15%) had a VAD at time of Tx listing. The VAD group was older, heavier, and had higher prevalence of cardiomyopathy, mechanical ventilation (MV), and impaired renal function. Unadjusted waitlist mortality was similar between the VAD and non-VAD groups (p=0.55, Figure), with the curves crossing ~90 days after listing. A multivariable Cox model showed infant age (HR 2.94, 95% CI 2.26-3.81), Black race (HR 1.59, 95% CI 1.33-1.90), congenital heart disease (HR 1.37, 95% CI 1.56-1.62), renal impairment (HR 2.62 95% CI 2.15-3.19), IV inotropes (HR 1.19, 95% CI 1.01-1.40) and MV (HR 2.58, 95% CI 2.13-3.13), were associated with one-year waitlist mortality. VAD use was not associated with mortality in the first 90 days after Tx listing (HR 0.87, 95% CI 0.65-1.18) but was protective for those waiting ≥90 days (HR 0.40, 95% CI 0.24-0.66). Conclusions: VADs reduce waitlist mortality in the current era, but only for those waiting ≥90 days after Tx listing. Potentially modifiable risk factors, including MV and renal impairment, are associated with mortality. These findings suggest that Tx listing without VAD may be a reasonable option if a short waitlist time is anticipated. However, VAD use may confer benefits, particularly for those expected to wait more than 90 days.
Abstract 9541: Comparing Patient Reported Outcomes and New York Heart Association Class Among Patients Hospitalized for Heart Failure
Authors: Michael F Cosiano, Andrew Vista, jie-lena sun, Brooke Alhanti, Josephine Harrington, Javed Butler, Christopher M OConnor, Adrian F Hernandez, Randall Starling, Robert J Mentz, Stephen J Greene
Journal: Circulation (2022)

Background: The New York Heart Association (NYHA) classification remains a cornerstone nomenclature for quantifying health status of patients with heart failure (HF). How this clinician-reported classification compares with patient-reported outcomes among patients hospitalized for HF is unclear. Methods: ASCEND-HF was a global randomized trial comparing nesiritide versus placebo among patients hospitalized for HF, irrespective of EF. Among patients with complete baseline data for NYHA class and the patient-reported EuroQOL-5 dimensions (EQ-5D), each scale was organized into 4 levels (NYHA Class I-IV; EQ-5D utility index [UI] 0.75-1.00, 0.50-0.74, 0.25-0.49, &lt;0.25 and EQ-5D visual analogue scale [VAS] 75-100, 50-74, 25-49, &lt;25). Levels of NYHA class and EQ-5D were then mapped to each other from “best” to “worst.” Minor and moderate-severe discordance were defined as NYHA class and EQ-5D differing by 1 level and ≥2 levels, respectively. Factors associated with moderate-severe discordance were then assessed via backwards selection multivariable regression. Results: Among 5,741 patients, concordance, minor and moderate-severe discordance between NYHA class and EQ-5D UI occurred in 22%, 40% and 38% of patients, respectively. For EQ-5D VAS, this categorization occurred in 29%, 48% and 23%. Discordance was more often due to worse NYHA class. Patients with moderate-severe discordance were more likely to have worse NYHA class and higher EQ-5D scores. NYHA Class IV, higher EQ-5D scores, race and geographic region were among multiple patient factors independently associated with moderate-severe discordance (Figure 1). Conclusions: In patients hospitalized for HF, the majority exhibited discordance between the clinician-reported NYHA class and patient-reported health status. Discordance was more often due to worse NYHA class. Multiple patient factors were independently associated with higher likelihood of moderate-severe discordance.
Abstract 9711: Association of Preoperative Body Mass Index With 30-Day Major Adverse Cardiovascular Events After Bariatric Surgery
Authors: Yifeng Yang, Kan Liu, Yangbo Sun
Journal: Circulation (2022)

Introduction: Despite bariatric surgery is the most effective and durable treatment for clinically morbid obesity, its association with intraoperative or 30-Day postoperative cardiovascular events after bariatric surgery is unclear. Hypothesis: To examine the association of preoperative body mass index (BMI) with adverse intraoperative or 30-day postoperative cardiovascular events after bariatric surgery. Methods: Our study extracted data from 785 321 patients who underwent bariatric surgery from 2015 to 2019 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), which covers more than 90% of all bariatric surgery programs in the United States and Canada. The exposures were preoperative BMI and highest recorded preoperative BMI. The main outcomes were intraoperative or 30-day postoperative major adverse cardiovascular events (MACE). Results: Of the 785 321 patients (mean [SD] age 44.8 [11.8] years; 79.9% women), 1 541 patients suffered at least one MACE event intraoperative or 30-day postoperative bariatric surgery. Compared with patients with a preoperative BMI of 35.0 to 39.9, the multivariable-adjusted ORs (95% CIs) for intraoperative or 30-day postoperative MACE events for patients with preoperative BMI of 40.0 to 44.9, 45.0 to 49.9, 50.0 to 54.9, and 55.0 and greater were 1.05 (95% CI, 0.91-1.21), 1.19 (95% CI, 1.02-1.38), 1.28 (95% CI, 1.07-1.53), and 1.77 (95% CI, 1.50-2.09), respectively ( P for trend &lt; 0.001). Moreover, compared with highest recorded preoperative BMI of 35.0 to 39.9, the multivariable-adjusted ORs (95% CIs) for intraoperative or 30-day postoperative MACE events for patients with preoperative BMI of 40.0 to 44.9, 45.0 to 49.9, 50.0 to 54.9, and 55.0 and greater were 1.20 (95% CI, 1.01-1.41), 1.18 (95% CI, 0.99-1.40), 1.32 (95% CI, 1.09-1.59), and 1.76 (95% CI, 1.48-2.10), respectively ( P for trend &lt; 0.001). Conclusions: In this study, we found that higher preoperative BMI and higher highest recorded BMI were both associated with a higher risk of MACE events intraoperative or 30-day postoperative bariatric surgery. These findings may help improve perioperative cardiovascular optimization and provide evidence for future updates of clinical guidelines regarding bariatric surgery.
Abstract 9752: Racial Differences in Prevalence and Impact of Subclinical Myocardial Injury Risk Factors
Authors: Mai Z Soliman, Sylvia Kozman, yabing li, Muhammad Ahmad
Journal: Circulation (2022)

Introduction: Racial differences in the prevalence and prognostic significance of electrocardiographic (ECG) subclinical myocardial injury (SCMI) have been reported. We examined whether these differences are explained by differences in the prevalence of SCMI risk factors or due to a differential impact of the same risk factors Methods: This analysis included 5,852 participants (58.5±13.1 years, 53.9% women, 52.5% white) from the Third National Health and Nutrition Examination Survey. SCMI was defined as the presence of a Cardiac infarction/injury score ≥ 10 points on the ECG. Logistic regression analysis was used to examine the association between potential SCMI risk factors with SCMI, overall and stratified by race. To examine if racial differences existed between risk factors and SCMI, multiplicative interaction terms between each risk factor and race were tested. Results: SCMI was more common in whites (23.3%) followed by black (21.8%), then Mexican Americans (18%); p-value &lt;0.01. Heterogeneity in the distribution of risk factors was observed. Whites were more likely to be older with a higher prevalence of dyslipidemia compared to other races. On the other hand, Blacks had a higher prevalence of hypertension compared to others, but a similar prevalence of obesity as Mexican Americans. Also, Mexican Americans were more likely to have lower income with a higher prevalence of diabetes and no regular exercise, than other races. Significant risk factors for SCMI were age, male sex, smoking, diabetes, hypertension, obesity, and no regular exercise. ECG left ventricular hypertrophy was associated with lower odds of SCMI. The associations of diabetes and no regular exercise with SCMI differed by race (Table). Conclusions: Racial differences in the prevalence of risk factors do not explain racial differences in SCMI. Among risk factors, diabetes and lack of physical exercise partially explain the higher prevalence of SCMI in Whites.
Abstract 9694: Incidence and Outcomes of Hospitalized Patients With Torsades de Pointes
Authors: Saurabh Sudesh, Geoffrey A Rubin, Marc Waase, Deepak Saluja, Jose Dizon, Elaine Y Wan, Angelo Biviano, Hasan Garan, Hirad Yarmohammadi
Journal: Circulation (2022)

Introduction: TdP is a polymorphic VT that occurs with prolonged QT interval and can cause sudden cardiac death. Trends in incidence and outcomes of TdP during the COVID-19 pandemic are not well-established. We aim to report incidence of intrahospital TdP and VT, baseline characteristics of patients with TdP, and trends in post-TdP recovery and mortality before and during the COVID-19 pandemic. Methods: Patients with diagnoses of VT and TdP from 2016-2020 at our institution were included. The diagnosis was confirmed after analysis of the patients’ ECGs. Demographics, medical history, and hospital course data were collected. Chi-square/Fisher’s exact, one-way ANOVA, and logistic regression analyses were conducted. Results: Seventy-four patients were included in the analysis. Average age was 60 ± 17, and 57% were male. Fifty-two (70%) patients were in the ICU at time of TdP. Co-morbidities included hypertension (53%), atrial fibrillation/flutter (41%), diabetes mellitus (34%), CAD (26%), and CKD (22%). Average LVEF was 39 ± 19%. Forty-two (57%) underwent emergent defibrillation, 19 (26%) required transvenous pacing, and 7 (10%) were administered isoproterenol for acute management of TdP. Median recovery time of QTc interval to &lt;500ms was 3 days. Twenty-two (30%) received an ICD. Follow-up device check data was available for 15 patients; 4 had at least 1 episode of NSVT. Fifteen (20%) patients died during their admissions. The proportion of patients with VT that had TdP increased in 2020 compared to prior years (p&lt;0.001). However, the proportion of patients with TdP that died during admission was not significantly different across 2016-2020. Conclusions: The proportion of patients with TdP relative to those with VT increased significantly in 2020, concurrent with the first wave of the COVID-19 pandemic. The absolute number of hospitalized patients with TdP did not change from 2016-2020. Mortality rate in patients with TdP did not differ significantly from 2016-2020.